The Effect of Early Immunoglobulin Treatment on the Course of Kawasaki Disease

Chae Ik Ra; Ki Hwan Kim; Jong Gyun Ahn; Dong Soo Kim

doi:10.4078/jkra.2010.17.4.386

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Ra, Kim, Ahn, and Kim: The Effect of Early Immunoglobulin Treatment on the Course of Kawasaki Disease

Original Article

J Korean Rheum Assoc 2010;17(4):386-393.

Published online: 23 December 2010

DOI: https://doi.org/10.4078/jkra.2010.17.4.386

The Effect of Early Immunoglobulin Treatment on the Course of Kawasaki Disease

Chae Ik Ra, Ki Hwan Kim, Jong Gyun Ahn, Dong Soo Kim

Division of Infectious Disease and Immunology, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea

Received 11 September 201013 October 2010 Accepted 14 October 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Controversies exist as to whether early treatment for Kawasaki disease might increase the need for additional intravenous immunoglobulin (IVIG) treatment and whether it could reduce cardiac complications. We conducted this study to add useful clues, which could be helpful when setting up a treatment plan.

Methods

359 patients who were newly diagnosed with Kawasaki disease at Severance Hospital were divided into two groups; patients who received IVIG treatment within 3 days (group A) and those who received IVIG treatment after 3 days (groups B and C). We compared the laboratory data, fever duration, frequency of additional IVIG treatment, and echocardiography follow-up results.

Results

IVIG was administered 1.11±0.34 (mean±SD), 1.15±0.39, and 1.17±0.42 times in groups A, B, and C, respectively; p=0.29 (A vs. B), p=0.21 (A vs. C). The incidence of cardiac complications checked within the first 2 weeks from disease onset was 3.6%, 5.2%, and 5.1% in groups A, B, and C, respectively; p=0.52 (A vs. B), p=0.55 (A vs. C), and the values checked at 2 months were 3.6%, 5.6%, and 5.7% in groups A, B, and C, respectively; p=0.43 (A vs. B), p=0.43 (A vs. C).

Conclusion

Early IVIG treatment in patients with Kawasaki disease decreased fever duration and may prevent cardiac complications by limiting inflammation.

Keywords: Kawasaki disease, Intravenous immunoglobulin

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Table 1.

Clinical features of the treatment groups

	Group A (N=110)	Group B (N=249)	Group C (N=175)	p-value
				A vs B	A vs C
Age (months)	27.5±21.2	35.3±26.2	33.0±26.2	<0.01	0.03
Sex	0.636	0.550	0.543	0.12	0.12
Fever duration before administration of IVIG (days)	2.38±0.82	6.04±2.77	4.78±0.70	<0.01	<0.01
Fever duration after administration of IVIG (days)	0.32±0.74	0.23±0.62	0.26±0.62	0.24	0.47
Total fever duration (days)	2.70±1.11	6.27±2.79	5.04±0.92	<0.01	<0.01
The number of times of IVIG administration	1.11±0.34	1.15±0.39	1.17±0.42	0.29	0.21
CAL Within 2 weeks from disease onset	4 (3.6%)	13 (5.2%)	9 (5.1%)	0.52	0.55
At 2 months from disease onset	4 (3.6%)	14 (5.6%)	10 (5.7%)	0.43	0.43

IVIG: intravenous intravenous immunoglobulin, CAL: coronary artery lesion

Table 2.

Laboratory values of the treatment groups

		Group A (N=110)	Group B (N=249)	Group C (N=175)	p-value
					A vs B	A vs C
WBC (/mm³)		13,132±4,974	13,013±4,940	12,747±4,878	0.86	0.71
ESR (mm/hour)	Initial value	45.1±32.1	61.9±36.7	60.7±36.4	0.01	0.01
	Increase after 3 days	22.8±27.8	17.6±28.3	17.3±28.4	0.17	0.18
CRP (mg/dL)	Initial value	4.2±4.8	5.8±5.9	6.5±6.1	<0.01	<0.01
	Increase after 3 days	–2.5±2.7	–4.1±4.9	–4.6±5.1	<0.01	<0.01

WBC: white blood cell, ESR: erythrocyte sedimentation rate, CRP: c-reactive protein

Table 3.

Differences between patients who received IVIG treatment once and those who received IVIG more than twice

		Number of times of IVIG administration		p-value
		1 (N±313)	≥2 (N±46)	p-value
Age (months)		33.6±25.7	28.0±19.0	0.08
Sex		0.59±0.49	0.50±0.51	0.26
CAL		0.05±0.36	0.28±0.83	0.44
Fever	Before IVIG	4.91±2.93	4.98±2.65	0.89
duration	After IVIG	0.18±0.46	0.76±1.30	<0.01
(days)	Total	5.10±2.91	5.74±2.93	0.16
ESR (mm/hour)	Initial value	56.1±36.5	60.5±33.6	0.44
	Difference after 3 days	18.9±28.6	20.6±24.9	0.74
CRP (mg/dL)	Initial value	5.4±5.8	4.6±4.3	0.38
	Difference after 3 days	–3.8±4.7	–3.0±3.6	0.32

IVIG: intravenous immunoglobulin, CAL: coronary artery lesion

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